Instructions for Use

Epogen® (Ee-po-jen)
(epoetin alfa)

Use these Instructions for Use if you or your caregiver has been trained to give
Epogen injections at home. Do not give yourself the injection unless you have
received training from your healthcare provider. If you are not sure about giving
the injection or you have questions, ask your healthcare provider for help.

Before reading these Instructions for Use, read the Medication Guide that comes
with Epogen for the most important information you need to know.

When you receive your Epogen vial and syringes make sure that:

• The name Epogen appears on the carton and vial label.

• The expiration date on the vial label has not passed. Do not use a vial of
Epogen after the expiration date on the label.

• The dose strength of the Epogen vial (number of Units per mL on the vial
label) is the same as your healthcare provider prescribed.

• You understand what the dose strength of Epogen means. Epogen vials
come in several dose strengths. For example, the dose strength may be
described as 10,000 Units/mL on the vial label. This strength means that
10,000 Units of medicine are contained in each 1 mL (milliliter) of liquid.
Your healthcare provider may also refer to a mL as a “cc.” One mL is the
same as one “cc.”

• The Epogen liquid in the vial is clear and colorless. Do not use Epogen if the
liquid in the vial looks discolored or cloudy, or if the liquid has lumps, flakes,
or particles.

• The Epogen vial has a color cap on the top of the vial. Do not use a vial of
Epogen if the color cap on the top of the vial has been removed or is missing.

• Use only the type of disposable syringe and needle that your healthcare
provider has prescribed.

• Do not shake Epogen. Shaking could cause Epogen not to work. If you
shake Epogen, the solution in the vial may look foamy and should not be
used.

• Do not freeze Epogen. Do not use a vial of Epogen that has been frozen.

• Store Epogen in the refrigerator between 36°F to 46°F (2°C to 8°C).

1
 • Keep Epogen away from light.

• Single-dose vials of Epogen should be used only one time. Throw the vial
away after use even if there is medicine left in the vial.

• After removing a dose from the multidose vial, store the vial in the
refrigerator (but not the freezer). Do not store the vial for more than 21
days.

• Throw away the multidose vial as directed by your healthcare provider:

o if there is not enough medicine left in the multidose vial for another
dose, or
o if it has been more than 21 days since you first put a needle into the
multidose vial.

How should I prepare for an injection of Epogen?

• Always keep an extra syringe and needle on hand.

• Follow your healthcare provider’s instructions on how to measure your dose

of Epogen. This dose will be measured in Units per mL or cc (1 mL is the
same as 1 cc). Use a syringe that is marked in tenths of mL (for example,
0.2 mL or 0.2 cc). Using the wrong syringe can lead to a mistake in your
dose and you could inject too much or too little Epogen.

Only use disposable syringes and needles. Use the syringes and needles
only one time and then throw them away as instructed by your healthcare
provider.

What do I need to know about the different types of Epogen vials?

Epogen comes in two different types of vials.

• Single-dose Vials
• Multidose Vials

The multidose vial of Epogen contains the preservative benzyl alcohol.

Benzyl alcohol has been shown to cause brain damage, other serious side
effects, and death in newborn and premature babies. Epogen that comes in
single-dose vials does not contain benzyl alcohol.

Important: Follow these instructions exactly to help avoid infections.

Preparing the dose:

1. Remove the vial of Epogen from the refrigerator. During this time, protect
the solution from light.
2. Do not use a single-dose vial of Epogen more than one time.

3. Do not shake Epogen.

4. Gather the other supplies you will need for your injection (vial, syringe,
alcohol wipes, cotton ball, and a puncture-proof container for throwing away
the syringe and needle). See Figure 1.

Figure 1

5. Check the date on the Epogen vial to be sure that the drug has not expired.

6. Wash your hands well with soap and water before preparing the medicine.
See Figure 2.

Figure 2

7. Flip off the protective color cap on the top of the vial. Do not remove the
grey rubber stopper. Wipe the top of the grey rubber stopper with an alcohol
wipe. See Figures 3 and 4.
 Figure 3 Figure 4

8. Check the package containing the syringe. If the package has been opened
or damaged, do not use that syringe. Throw away the syringe in the
puncture-proof disposable container. If the syringe package is undamaged,
open the package and remove the syringe.

9. Using a syringe and needle that has been recommended by your healthcare
provider, carefully remove the needle cover. See Figure 5. Then draw air
into the syringe by pulling back on the plunger. The amount of air drawn
into the syringe should be equal to the amount (mL or cc) of the Epogen
dose prescribed by your healthcare provider. See Figure 6.

Figure 5 Figure 6

10.With the vial on a flat work surface, insert the needle straight down through
the grey rubber stopper of the Epogen vial. See Figure 7.

11.Push the plunger of the syringe down to inject the air from the syringe into
the vial of Epogen. The air injected into the vial will allow Epogen to be
easily withdrawn into the syringe. See Figure 7.
 Figure 7

12.Keep the needle inside the vial. Turn the vial and syringe upside down. Be
sure the tip of the needle is in the Epogen liquid. Keep the vial upside down.
Slowly pull back on the plunger to fill the syringe with Epogen liquid to the
number (mL or cc) that matches the dose your healthcare provider
prescribed. See Figure 8.

Figure 8

13.Keep the needle in the vial. Check for air bubbles in the syringe. A small
amount of air is harmless. Too large an air bubble will give you the wrong
Epogen dose. To remove air bubbles, gently tap the syringe with your
fingers until the air bubbles rise to the top of the syringe. Slowly push the
plunger up to force the air bubbles out of the syringe. Keep the tip of the
needle in the Epogen liquid. Pull the plunger back to the number on the
syringe that matches your dose. Check again for air bubbles. If there are
still air bubbles, repeat the steps above to remove them. See Figures 9 and
10.
 Figure 9 Figure 10

14.Double-check that you have the correct dose in the syringe. Lay the vial
down on its side with the needle still in it until after you have selected and
prepared your site for injection.

Selecting and preparing the injection site:

Epogen can be injected into your body using two different ways (routes) as
described below. Follow your healthcare provider’s instructions about how you
should inject Epogen. In patients on hemodialysis, the intravenous (IV) route is
recommended.

1. Subcutaneous Route:

• Epogen can be injected directly into a layer of fat under your skin. This is
called a subcutaneous injection. When giving subcutaneous injections,
follow your healthcare provider’s instructions about changing the site for
each injection. You may wish to write down the site where you have
injected.

• Do not inject Epogen into an area that is tender, red, bruised, hard, or has
scars or stretch marks. Recommended sites for injection are shown in
Figure 11 below, including:

o The outer area of the upper arms

o The abdomen (except for the 2-inch area around the navel)
o The front of the middle thighs
o The upper outer area of the buttocks
 Figure 11

• Clean the skin with an alcohol wipe where the injection is to be made. Be
careful not to touch the skin that has been wiped clean. See Figure 12.

Figure 12
• Double-check that the correct amount of Epogen is in the syringe.

• Remove the prepared syringe and needle from the vial of Epogen and
hold it in the hand that you will use to inject the medicine.

• Use the other hand to pinch a fold of skin at the cleaned injection site. Do
not touch the cleaned area of skin. See Figure 13.

Figure 13

• Hold the syringe like you would hold a pencil. Use a quick “dart-like”
motion to insert the needle either straight up and down (90-degree angle)
or at a slight angle (45 degrees) into the skin. Inject the prescribed dose
 subcutaneously as directed by your doctor, nurse or pharmacist. See
Figure 14.

Figure 14

• Pull the needle out of the skin and press a cotton ball or gauze over the
injection site and hold it there for several seconds. Do not recap the
needle.

• Dispose of the used syringe and needle as described below. Do not reuse
syringes and needles.

2. Intravenous Route:

• Epogen can be injected in your vein through a special access port placed
by your healthcare provider. This type of Epogen injection is called an
intravenous (IV) injection. This route is usually for hemodialysis patients.

• If you have a dialysis vascular access, make sure it is working by

checking it as your healthcare provider has shown you. Be sure to let
your healthcare provider know right away if you are having any problems,
or if you have any questions.

• Wipe off the venous port of the hemodialysis tubing with an alcohol wipe.
See Figure 15.

Figure 15
 • Insert the needle of the syringe into the cleaned venous port and push
the plunger all the way down to inject all the Epogen. See Figure 16.

Figure 16

• Remove the syringe from the venous port. Do not recap the needle.

• Dispose of the used syringe and needle as described below.

How should I dispose of the vials, syringes, and needles?

Do not reuse the single-dose vials, syringes, or needles. Throw away the vials,
syringes, and needles as instructed by your healthcare provider or by following
these steps:

• Do not throw the vials, syringes, or needles in the household trash or

recycle.

• Do not put the needle cover back on the needle.

• Place all used needles and syringes in a puncture-proof disposable

container with a lid. Do not use glass or clear plastic containers, or any
container that will be recycled or returned to a store.

• Keep the puncture-proof disposable container out of the reach of children.

• When the puncture-proof disposable container is full, tape around the cap
or lid to make sure the cap or lid does not come off. Throw away the
puncture-proof disposable container as instructed by your healthcare
provider. There may be special state and local laws for disposing of used
needles and syringes. Do not throw the puncture-proof disposable
container in the household trash. Do not recycle.

Keep Epogen and all medicines out of reach of children.

These Instructions for Use have been approved by the U.S. Food and Drug
Administration.
Manufactured by:

Amgen Inc.
One Amgen Center Drive
Thousand Oaks, CA 91320-1799 U.S.A.

Revised: 05/2012

© 1989-2012 Amgen Inc. All rights reserved.

1xxxxxx - v3 PMV 3